Medicare

Medicare is a federal health insurance program established to help Americans 65 years or older, and those considered as disabled, pay for health care. The program is designed to assist individuals in paying health care bills associated with short-term challenges of a sudden and acute nature. From its inception, the law has authorized Medicare payment for qualified Christian Science nursing services provided in Christian Science nursing facilities certified by the federal government as Medicare providers. Arden Wood, Broadview, Fern Lodge, Olive Glen, and Sunland are certified Medicare providers, and are classified by the federal government as Religious Nonmedical Health Care Institutions (RNHCIs).

As with most insurance programs, Medicare does not pay the entire bill for covered care. It has deductibles and coinsurance requirements that require you to pay part of the costs. There are two major parts to Medicare called Part A and Part B.

Medicare Part A and Part B

Medicare Part A

Part A is called “Hospital Insurance” and helps pay for room, board, covered nursing care and nursing supplies in either a hospital or accredited nursing facility (see sections on Eligibility for Medicare Reimbursement). Because Christian Science nursing facilities are classified as RNHCIs, they are considered “hospitals” for the purposes of Medicare Part A coverage.

Medicare Part B

Part B is called “Medical Insurance” and can only be used on the recommendation of a physician. This would cover various medical procedures and equipment (see sections on Eligibility for Medicare Reimbursement). It would never be used at Christian Science nursing facilities because they have no medical physicians.

There is no charge for Part A coverage. It is a part of Social Security benefits. However, there is a monthly premium charged for Part B coverage. This monthly charge is at least $109 in 2016, but can be substantially higher depending on your income. This monthly premium is automatically deducted from Social Security payments unless specifically declined in writing 60 days after one becomes eligible to receive Social Security benefits. At the time of your Social Security interview to sign up for retirement benefits and/or Medicare, you can verbally decline either part of Medicare.

Applying for Medicare

If you are nearing age 65, are not already receiving Social Security or Railroad Retirement benefits and want to qualify for Medicare benefits, you must apply for Medicare Part A and you may wish to consider enrolling in Part B. You should call the Social Security Administration at 800-772-1213, or visit your local Social Security office 3-6 months before your 65th birthday.

Enrolling in Part A is included as part of your Social Security benefits at no additional cost to you. Although reenrolling in Part B for an additional cost is optional, you are automatically enrolled in Part B at the time you sign up for Social Security benefits unless you specifically decline it. You can enroll in Part B for up to three months after eligibility. However, if you wait until the month you turn 65 or later to enroll, enrollment will not take effect immediately, and the delays increase the longer you wait. If you miss this first enrollment period, you have to wait until the next January to enroll, and coverage will not begin until the following July.

A few things to consider about accepting or declining Part B coverage:

Part A is called ”Hospital Insurance” and helps pay for room, board, nursing care, and supplies in either a hospital or Christian Science nursing facility. Part A is used at Christian Science nursing facilities. Part B is called “Medical Insurance” and can only be used on the recommendation of a physician. This covers various medical procedures and equipment such as the setting of bones, ambulance to a medical hospital, rental or purchase of a wheelchair, walker, etc., with the approval of a physician.

If you plan to purchase a Medigap or Medicare Supplement Insurance Plan (see Health Insurance section under Financial Assistance), these would usually require Part B coverage.

If at any time in the future you decided to enroll in Part B coverage, there is a permanent 10% surcharge added onto the premium for every 12 months that you could have been, but were not, enrolled in this program.

Christian Science nursing care must meet very specific criteria to qualify for Medicare reimbursement. For Medicare purposes, the nursing care must require the judgment, skill, oversight, observation, or direct care of a Journal-listed Christian Science nurse. Generally, the nursing need must include at lease one of the following:

Full care in bed

The full assistance of one or more nurses to walk

The dressing and bandaging of a wound

Assistance to ensure proper and adequate nourishment

It is not unusual for Medicare coverage to vary during the course of a benefit period since the nursing needs of a patient may change. An assessment is made daily to determine if the needed care continues to qualify for Medicare coverage. For that reason, Medicare coverage does not necessarily start when Christian Science nursing care begins nor does it always remain in place for the duration of a patient’s stay in a facility.

Again, to be eligible to receive Medicare benefits, a person must be at least 65 years of age and sign up for Medicare at a Social Security office. Individuals who are not yet 65 may also qualify because of certain claims of disability. A Medicare card will be issued when eligibility is established.

Note: Normally, a medical diagnosis is needed to confirm eligibility. However, there is a special provision in the Medicare law that allows an individual to utilize his or her Medicare benefits at a Religious Nonmedical Health Care Institution without a medical diagnosis. Medicare recognizes Arden Wood, Broadview, Fern Lodge, Olive Glen, and Sunland as Religious Nonmedical Health Care Institutions. All are periodically inspected and re-certified for this purpose under Medicare.

Conditions Not Eligible for Medicare Reimbursement

There are circumstances that warrant nursing assistance but which, in and of themselves, are not eligible for Medicare reimbursement. These include, but are not limited to, inability to stay at home alone, anxiety or depression, incontinence, and mental confusion. Christian Science nurses may lovingly and skillfully care for these needs, but the cost is not reimbursable by Medicare. Each patient or family member should inquire about financial assistance available at a nursing facility as well as refer to the section on Financial Assistance.

Medicare Coverage for Christian Science Nursing Care

For patients whose nursing need qualifies for Medicare reimbursement, the following lists indicate what Medicare will reimburse and will not reimburse.

Medicare Part B does not pay for:

Medicare Part A Coverage Schedule, Deductible, and Co-Payments

It is important to understand that if the healing occurs in two or three days, that is how long the coverage will last. We never expect to need extended care because we expect quick and complete healing. But if the healing progresses more gradually, there are limits to how long Medicare coverage is available.

Initial Period (first 60 days)

The patient is responsible for the first $1,316 (2017)* of their Medicare covered charges which appear on their first bill. Medicare will reimburse all remaining charges for room, board, nursing care, and most supplies for a period up to 60 days.

Co-Insurance Period (next 30 days)

Medicare Part A Hospital Benefits will continue to reimburse some charges for an additional 30 days. During this period, the patient is responsible for all care costs up to the daily deductible of $329 per day (2017)*. Medicare will pay the rest of the eligible daily costs charged to the patient.

Lifetime Reserve (additional 60 days possible)

The Lifetime Reserve option can be utilized only once in a lifetime. If a person has used 90 days of coverage and still needs care that qualifies for Medicare reimbursement, he or she can elect to use their Lifetime Reserve. Under this Lifetime Reserve option the patient is responsible for paying the daily deductible of $658 a day (2017)*.

MEDICARE PART A (2017) – What you pay.*

Initial Period (60 days)

Deductible $1,316

Coinsurance Period (next 30 days)

$329 per day

Lifetime Reserve (60 days possible)

$658 per day

*For subsequent years, contact Medicare at 800-633-4227 or your local Christian Science nursing facility for the current amount.

Medicare Benefit Period

A Medicare benefit period begins when a facility determines that a patient’s nurse need qualifies for Medicare reimbursement (see guidelines in opening section on Medicare). As long as the nursing care continues to meet these eligibility guidelines, Medicare will reimburse 100% of a patient’s bill for 60 days (less an initial deductible – see section above). If the nursing care continues as eligible for Medicare reimbursement after these 60 days, there is another 30 days of partial coverage available during which the patient pays a daily deductible (see section above) and Medicare will reimburse the remainder of the bill. This combined 90 days is generally known as the benefit period. After this 90 day period of Medicare-eligible reimbursement, a patient may also choose to use their one-time only benefit of 60 additional days, called the Lifetime Reserve. (Generally the daily deductible during this period is greater than most facilities’ fees – see section above.)

A patient may qualify again for a new benefit period if all of the following conditions are met: (1) the required care still meets the eligibility requirements for Medicare reimbursement (see guidelines in opening sections on Medicare); and (2) more than 60 consecutive days have elapsed since Medicare-eligible care was needed.

The Medicare Election Process

To utilize Medicare benefits at a Christian Science nursing facility, a patient is required to elect to receive care in a Religious Nonmedical Health Care Institution based on his or her own religious convictions. A patient needs to sign and have notarized an election form at the time of admission stating that the signer desires to use their Medicare benefits at a Religious Nonmedical Health Care Institution. These forms are available at nursing facilities and a notary public is also often available. The form must be signed either by the patient, a legal guardian, or a designated agent under an Advance Health Care Directive. If a patient is unable to sign for himself and there is no one legally designated to do so, Medicare will not reimburse any amount of the bill. A spouse or child is not eligible to sign this form unless designated in a Health Care Power of Attorney. Please see AHCD section on how an Advance Health Care Directive can avoid this potential problem.

This election can be revoked at any time if for any reason he or she decides to pursue medical care.

IMPORTANT: See Restrictions on Switching Between Christian Science Nursing Care at a Nursing Facility and Medical Care in following section.

Restrictions on Switching Between Christian Science Nursing Care at a Nursing Facility and Medical Care

Medicare restricts switching between Christian Science nursing facility coverage and medical care coverage of any sort. If Medicare benefits are used for any medical purpose, (such as obtaining a wheelchair, removal of a cast, ambulance services, or even removing ear wax or cutting toenails), the Christian Science election is automatically revoked.

The first time an election has been revoked, you are entitled to execute a new election when you are readmitted to the Christian Science nursing facility and you will be immediately eligible for Medicare benefits. It is suggested you speak with the administration at one of the accredited facilities on how to obtain these services without revoking your Christian Science election.

If you revoke the second election, you must wait one year before a third election will become effective. This does not mean you cannot receive care at a Christian Science nursing facility; it only means that Medicare will not pay for that care.

Switching three times or more requires a wait of five years before an individual is allowed to receive Medicare reimbursement again in a Christian Science nursing facility. Use of Medicare benefits for covered care in a medical facility is available at any time.

Although Health Maintenance Organizations (HMOs) are legally required to honor the use of Medicare benefits at a Christian Science nursing facility, prior written authorization from the HMO is usually required. If such authorization cannot be obtained, the patient may have to withdraw from the HMO in order to reinstate Medicare benefits that cover care in a Christian Science nursing facility.

Documents Needed When Entering a Christian Science Nursing Facility

Patients should bring the following documents:

Copies of any legal documents providing for a Power of Attorney, Conservator, or Advance Health Care Directive

Additional Information on Medicare

More information on Medicare can be obtained from a Christian Science nursing facility or from the publications listed below. You can also access a highly informative booklet, Medicare and its Provision for Religious Nonmedical Healthcare for Christian Scientists at Arden Wood’s website www.ardenwood.org. For information on enrolling in Medicare, replacing a lost Medicare card, and general questions about Medicare, call the Social Security Administration at 800-772-1213. For additional information on Medicare, Medigap policies, programs that help pay health care costs, or to request publications, call Medicare at 800-633-4227.

Note: If you talk to Medicare or Social Security about benefits at a Christian Science nursing facility, it is extremely important to communicate that you are talking about Hospital Benefits in Part A of Medicare covered under Religious Nonmedical Healthcare Institutions and not Skilled Nursing Facility benefits.

We gratefully acknowledge the assistance of Arden Wood and High Ridge House in the preparation of this section.

Medicare

For questions about Medicare, Medigap policies, programs that help pay health care costs, or to request a copy of any of the following publications, call Medicare toll-free at 800-633-4227 or download the publications from the Medicare website at www.medicare.gov.

Publication #10050 Medicare and You – a summary of Medicare benefits, rights and obligations, and answers to frequently asked questions about Medicare.

Publication #10116 Your Medicare Benefits – an explanation of Part A and Part B benefits.